Tall-tube for controlled intubation and drainage of the common bile duct



March 4, 1952 SHULMAN 2,587,910

TTUBE FOR CONTROLLED INTUBATION AND DRAINAGE OF THE COMMON BILE DUCTFiled Dec. 23, 1949 STOMACH INVENTOR.

ALEXANDER G. SHULMAN Patented Mar. 4, 1952 UNITED STATES PATENT OFFICET-TUBE FOR CONTROLLED INTUBATION AND DRAINAGE OF THE COMMON BILE DUCTAlexander G. Shulman, Los Angeles, Calif.

Application December 23, 1949, Serial No. 134,775

of the common bile duct.

It is one object of the herein described invention to provide animproved T-tube which will overcome the disadvantage of presently usedtypes which upon becoming obstructed necessitate Waiting until clinicalsigns of cholangitis become evident and indicate such obstruction. Inthe tube of the present invention, such obstruction would be indicatedimmediately, and proper treatment may be taken to eliminate and correctthe situation. Moreover, the usual need for post-operative X-rayphotographs of the common bile duct is eliminated, since the common bileduct cannot become occluded when my improved tube is utilized, withoutprevious evidence of such fact.

A further object of the invention is to provide such a tube which willpermit total alimentation of the patient directly into the duodenum withsaline, glucose solutions, amino acid mixtures, hydrolysed proteins ornatural food mixtures, by in J'ecting the substances through the portionof the end of the tube which lies in the duodenum.

A further object of the invention is to provide an improved T-tubeconstruction which is so arranged that the rate of bile outflow can bereadily determined by collecting the bile outflow for a desired time,and which will permit the collected bile to subsequently be reinjectedinto the duodenum. Thus the tube of the present invention 'isadvantageous in that it may be used for diagnostic purposes to determinethe presence crabsence of liver disease.

Another object is to provide an improved T-tube construction which is soarranged that the bile flow may be readily controlled and graduallyreleased. Slow decompression of the biliary system is thus made possibleand prevents the theoretical danger of sudden decompression of the liverradicals to which the so-called liver deaths have 'the'flow channel. aFurther objects and advantages of the invention will be brought out inthe followin part of the specification, wherein detailed description isfor the purpose of fully disclosing preferred and modified embodimentsof the invention without placing limitations on its scope.

Referring to the drawings, which are for illustrative purposes only:

Fig. 1 is a view diagrammatically illustrating the use of a T-tubeembodying the features of the present invention;

Fig. 2 is an enlarged view, partly in section, and certain parts beincut away to more clearly show specific details of construction; and

Fig. 3 is a modified form of the invention.

Referring generally to Fig. 1, a T-tube as generally indicated at A, andconstructed according to the present invention, is disclosed in aposition of use. It will be noted that the T-tube comprises generally across-limb II) connected with a trunk I I connecting at its distal endwith a, looped portion I2.

More specifically, the cross-limb I0 is positioned within the commonbile duct I3 which conducts the bile fluid from the liver, as indicatedat I4, and communicates through the sphincter of Oddi 15 with the lumenof the duodenum I6. The

trunk I I extends laterally through the abdominal wall H, the loopedportion 12 being positioned externally for various purposes as willhereafter be more fully explained. One form of construction of a T-tubeembodying the present invention is shown in Fig. 2. In thatconstruction, the cross-limb I0 is in two parts consisting of a shortsingle lumen tube I8 and a long single lumen tube #9, these two tubesbeing axially aligned and positioned in end-to-end respectivelycommunicate with the lumina of the tubes I8 and I9 on each side of thepartition 20. At the distal end of the tube 2I, the lumina respectivelycommunicate with a tube connector of suitable material as indicated at22. In the present instance, the connector comprises a pair of metaltubes 23-23 which are soldered. or otherwise secured togetherintermediate their ends as indicatedat 24 so as to form parallelconnecting tube end portions 25-45 adapted to be inserted in the laminaof the tube 2|. The other ends of 3 the tubes 23-43 are deformed so asto diverge outwardly, and are provided with bulbous ends 26-26.

The looped portion I2 comprises a U-shaped section 21 of transparentglass or other suitable material, the section having bulbous connectionends 28-48. The ends 28-28 of the section 21 are respectively connectedto the ends 26--26 of the tube. connector 22 by means of short tubes29-29 of flexible material.

A modified and simplified construction is shown in Fig. 3. In thisconstructiQn, two. L shaped single lumen tubes 30-30 havingright;angledv end portions 3 l-3I are secured together in backto-backrelation by means of a bonding material 32, and with the legs 3l3l.extendingdn op posite directions but in axial, alignment with each.

other. The bonding material 32 extends from the end portions 3I3l to apoint 33 whic h be described. Following surgical exploration of thecommon bile duct, the tube is positioned as shown in Fig. 1 so as totemporarily drain the cqmmehb e u il ali The sh t. t b 3 is insertedinto the proximal. portion oi. the common. bi e du 1 he di o h h and hehe ub l9. e ten s, m h is ltertion of the duct through the. sphincter ofOdd into the lumen of; the duodenum. If it is desired that this endshould not pass through the sphincter, the tube may be shortened bycutting it to} thefdesired length, The diameter of the tubes. I8. and lewill be provided in suitable size tonu yv ithin he h mh il d t n whichit is to be installed, During ordinary operation, flow of bile throughthe tube will be in the, directions indicatedby the arrows in Fig. 1.With the trunk l I extending through the abe dominal wall, and thelooped portion, [2; positioned. outside, the bile flow may be. readilycontrolled by means, of. a suitable clamp placed on oneof the tubesections 29.

Whehu l zih h I-fi b -fo l m h a h. 2f the. patient directly into theduodenum, this' is accomplished by disconnecting the looped porionir mte pw rm e d 25 f. the. onnect 22 and by connectingthereto suitablemeansfor injecting the desiredsolution or mixturesthrough the'tube' [9connecting with the duodenum In. diagnostic work, the upper connectingtube ot the tube connector 22 maybe connected, to suitable collectingvessel for receiying the bile outpi ts are l an by timin the eflectithe. rat hf fl w fr m th i r ay e. prope determined.

The. T-tubeof thepresent invention. is. partic. ularly advantageoussince any obstruction to flow isindicatedat once without the-necessityof-haying to wait for clinical signs of cholangitisa In the event of anobstruction,this obstructionmay be relieved by irrigation and suction,Controlled irrigation through the tube- [9 with saline-,: anaestheticsolutions or ether for the dissolution of stones is possible withoutdanger orpaindue to regurgitation or evaporation of irritating and toxicsubstances in the direction of the liver. Controlled undissipatedsuction on the tube is possible in the presence of overlooked smallstones or debris so that such material. may.- be cap u ed a d prevent dom passihe 0.1. own into he Q Q nq ohs 0f he qmrhohbi d c The presentT-tube is advantageous of use over the ordinary type of tube in that,where the opening at; the lower-end of tube; I 9, may be obstructedbyalfold-of duodenal mucosa, uch fold may be pushed aside by injecting asmall amount of saline into that arm of the double lumen portion of. thetube which leads directly to the obtructed. n

I' claim as, my. invention:

1. A device of the character described. comprising: asingle lumen firsttube; partition means insaid tube separating it into a short upper limband a relatively longer lower limb; a double lumen second tube extendinglaterally from said first tube and forming therewith a generally T- hed. truc re. the. m na a one. and Q? the second. tub in r ect velx in. omunicat hwith h hteit r o he. fi st, uba h. 0121 .0: site sides of saidpartition neans; metallic tabui r. chhhectors.commun cat ng w h theumihe. at h o h r n of he cohd ube; a re s e' h be; and f exiblubularqqhhe tiohs-remhv hh' connecting h nd o h rahsnarehtthbe. with themetal onnec o s.

A. ev o the haracte escribe c.0 32- p i n s e e l m n. firsttubenpartiti in s id t e a at n itihtos g io s 035 3169111 1 h qo neihathe end of h tren arehttuhh V h. hev m a hnectm' f 3. Aj device ofthe character described, com,- p ezh ihe e r b pa t ti n-m ans d, t be;ub e u chhd. ube. xten ing hte a la m said fir t ub and fa ming her witha g nera ly h ed'st uc re. he lumina'at, one end of the; second tubebeing re s eqti el in c mmu at on h he n eri r o th r t ub n, opp s e.de f a ert ti h m ans; id. bula o nector pmm a he with. th emma at. he ohe e d f e second tub at ah herent be; nd. con c i ns e.- tween the endof the transparent tube andfthe rigid tubular connectors.

m htatioa a d hen-n0 fdr hee hmueh he 9mm .hfleducthomh isine; a ha r-otubhs in quart whine; p r i i n. m a s ppes h direct be we n he a jacent2.9 of; aid tuh srehdmeans.definin at rall e n he looped flow connectionfrom the adjaeentgtube nd on on i e: .aicl1 n r it qhitq; t e adja ewheehd; on. the: other; ide Qt a d pert tim.

connection between the other set of ends of said 2 trunk fiow passages;and a transparent window for viewing material flowing through a trunkflow passage.

'7. A device of the character described for alimentation and control ofdrainage through the common bile duct, comprising: a pair of tubes inend-to-end relation; means opposing direct flow between the adjacentlydisposed ends of said tubes; means defining a plurality of lateral trunkflow passages respectively communicating at one set of their ends withthe interior of said pair of tubes at the adjacently disposed ends; anda flow connection between the other set of ends of said trunk flowpassages including a transparent section through which the flow thereinis visible.

8. A device of the character described for alimentation and control ofdrainage through the common bile duct, comprising: a pair of tubes inend-to-end relation; means opposing direct flow between the adjacentlydisposed ends of said tubes; means defining a plurality of lateral trunkflow passages respectively communicating at one set of their ends withthe interior of said pair of tubes at the adjacently disposed ends; anda disconnectable flow connection between the other set of ends of saidtrunk flow passages.

9. A device of the character described, comprising: elongate tubularmeans having its end portions deflected at right-angles, said meansbeing looped between its ends; means securing A opposite side portionsof the loop together with the deflected end portions axially aligned andextending in opposite directions to form with the secured portions ofthe loop a. generally T-shaped structure; and a, disconnectabletransparent section in said loop.

10. A device of the character described, comprising: a tube adapted tobe positioned in the common bile duct for conducting flow of bile fromthe liver to the duodenum, said tube having a partition inwardly spacedfrom one of its ends; tubular means defining a by-pass flow passagearound said partition, said means including a looped portion adapted tobe positioned exteriorly of the abdominal wall; and a transparent wallsection in said looped portion through which the flow may be observed.

11. A device of the character described for alimentation and control ofdrainage through the common bile duct, comprising: means definingaligned tubular main passages in end-to-end relation: means opposingdirect flow between adjacently disposed ends of said main passages;means defining a plurality of lateral trunk flow passages, each of saidtrunk passages communieating at one of its ends with the interior of oneof the adjacently disposed ends of said main passages; and a flowconnection between the other ends of said trunk flow passages.

ALEXANDER G. SHULMAN.

REFERENCES CITED The following references are of record in the file ofthis patent:

UNITED STATES PATENTS.

Number Name Date 1,234,106 Hodgson July 1'7, 1917 FOREIGN PATENTS NumberCountry Date 191,092 Switzerland Aug. 16, 1937 OTHER REFERENCES Items G.O. 2372 and G. O. 2374 on page 391 of the Complete General Catalog of V.Mueller and 00., published in 1938. Address of V. Mueller and Co., OgdenAvenue at Van Buren Street. Chicago, Illinois.

